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Jo Lloyd, PhD BABCP ACT Special Interest Group

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1 Jo Lloyd, PhD BABCP ACT Special Interest Group
Psychological Flexibility and ACT in the Workplace: Understanding and Improving Health and Performance Jo Lloyd, PhD BABCP ACT Special Interest Group

2 Psychological flexibility
Psychological flexibility refers to a person’s ability to focus on the present moment, as a conscious human being, and based on what the situation affords, act in accordance with ones chosen values. Psychologically flexible people are better able to: Be mindful of unwanted thoughts (e.g., self-doubt), feelings (e.g., fear), and impulses (e.g., avoid) Identify, prioritise, and pursue their values and goals The particular ‘goal-related’ feature of psychological flexibility is what makes this individual characteristic particularly relevant for job-related outcomes such as performance, motivation, absenteeism and mental health at work. Published research focussing on the construct of psychological flexibility in the workplace will now be reviewed.

3 Psychological flexibility and its influence on important workplace outcomes

4 Psychological flexibility & health and performance (Bond & Bunce, 2003)
Key issues: Work design and individual characteristics key determinants of mental health and performance. Can individual-focussed constructs from clinical psychology explain performance, as well as mental health-related outcomes at work? Previous cross-sectional studies do not acknowledge potential for reciprocal effects. Key findings: Psychological flexibility (at T1) predicted mental health, and an objective measure of job performance (at T2), over and above job control, negative affectivity and locus of control. Psychological flexibility also interacted with job control (at T1) to impact mental health, and an objective measure of job performance (at T2). Psychological flexibility an important longitudinal predictor.

5 Psychological flexibility & workplace learning (Bond & Flaxman, 2006)
Key issues: Modern work practices mean that people need to continually acquire new knowledge and skills. Important to identify individual and work design characteristics that enhance people’s ability to maximise their learning. Job control (active learning) and psychological flexibility (awareness) Builds on previous study by investigating whether job control, psychological flexibility, and the interactive relationship between the two can predict greater learning (objectively assessed), in addition to better performance and mental health. Key findings: Results supportive of both main and interactive effects. Due to the interactive effects of psychological flexibility and job control, future interventions may wish to promote both.

6 Psychological flexibility enhances job control (Bond, Flaxman & Bunce, 2008)
Key issues: Both previous studies found interactions between psychological flexibility and Job control, but can psychological flexibility enhance the impact of a work reorganisation intervention designed to improve job control. Participative action research (PAR) intervention vs. no treatment condition measured pre (T1) and post (T2) PAR. Key findings: PAR improved mental health and absenteeism and these effects were enhanced in people with higher levels of psychological flexibility. People who had higher levels of psychological flexibility perceived that they had greater levels of job control as a result of the intervention, and this greater perception of control led these people to experience even greater improvements in mental health and absenteeism. Psychological flexibility allows people with more job control to better notice, where, when and the degree to which they have it, and therefore better recognise goal-related opportunities.

7 Incremental validity If psychological flexibility is an important determinant of mental health and behavioural effectiveness at work, it must be shown to predict important outcomes above other individual characteristics. Psychological flexibility has been found to predict: Mental health and an objective measure of job performance over and above negative affectivity and locus of control (Bond & Bunce, 2003). Mental and physical health symptoms over and above emotional intelligence (Donaldson & Bond, 2004) Mental health, job satisfaction, turnover intention and absenteeism after controlling for each of the Big Five Personality factors (Bond, in prep)

8 ACT worksite interventions

9 Psychological flexibility and ACT
Psychological flexibility is promoted via Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999). ACT is a contemporary cognitive behavioural therapy (CBT)-based treatment approach. Whilst originally developed for use within clinical populations, ACT has more recently been found to be effective for engendering change in various applied domains, including the workplace. ACT may be reconceptualised into a worksite training intervention. Published research utilising ACT as a means of improving health and performance in the workplace, as well as examining important issues in this domain, will now be reviewed.

10 ACT vs. other SMIs (Bond & Bunce, 2000)
Key Q: how do different individual-focussed worksite stress-management interventions (SMIs) impact mental health and work-related outcomes in employees of a media organisation? Emotion-focussed SMI (based on ACT) which sought to increase psychological flexibility. Problem-focussed SMI (based on an Innovation Promotion program [IPP]) which sought to increase Work Change attitudes No treatment (waitlist control) group Key findings: Both interventions impacted mental health and work (propensity to innovate) outcomes, relative to the no treatment group. Changes occurred due to the hypothesised mediators of change. Uncovering mediators of change allows us to show that interventions are consistent with the theories that underpin them.

11 ACT vs. other CBTs (Flaxman & Bond, 2010a)
Key Q: how do different CBT-focussed worksite SMIs impact psychological distress outcomes in employees of a local government organisation? Acceptance and commitment therapy (ACT) condition which sought to increase psychological flexibility Stress inoculation training (SIT) condition which sought to reduce dysfunctional cognitions. No treatment (waitlist control) group Key findings: Both interventions were equally effective in reducing psychological distress. Whilst the mediation hypothesis held for the ACT condition, improvements in the SIT condition were not mediated by a reduction in dysfunctional cognitions. Comparing different CBT approaches allows us to show that they are theoretically distinct from one another.

12 Pre-intervention distress (Flaxman & Bond, 2010b)
Key Q: How do pre-intervention levels of psychological distress influence the impact of an ACT SMI on local government workers’ mental health? ACT vs. No treatment (waitlist control) group Key findings: ACT resulted in significant improvements in mental health for the sample as a whole across a six month assessment period. The beneficial impact of ACT was significantly moderated by initial level of distress, such that significant change was found only among a subgroup of more distressed participants. Finally, ACT was able to elicit clinically significant change in a majority (69%) of initially distressed participants who attended the training. Support the use of CBT principles and skills in nonclinical contexts

13 Psychological flexibility: levels of explanation & measurement

14 Psychological flexibility: levels of explanation & measurement
The technical explanation Psychological flexibility can be understood in terms of behavioural principles Cognitive/verbal behaviour vs. environmental contingencies The degree to which a person’s actions are directed by certain kinds of cognitive/verbal behaviour (e.g., thoughts and feelings), over and above environmental contingencies (e.g., the needs of the situation). Acceptance and Action Questionnaire-II (AAQ-II; Bond, Hayes, et al., submitted) assesses psychological flexibility as a unidimensional process consisting of two interrelated steps: acceptance and action All of the aforementioned studies assessed psychological flexibility in this way.

15 Psychological flexibility: levels of explanation & measurement
The mid-level explanation Psychological flexibility can also be understood in terms of middle level constructs which constitute a kind of ‘operating system’ for people less concerned with technical principles. Middle level constructs are often needed to provide a link between basic technical principles and theories of pathology, health and intervention. From this perspective, psychological flexibility can be divided up into individual processes, and groups of processes. There are various measures which tap into these individual processes and larger groupings of them.

16 The hexaflex: the mid-level explanation
Acceptance and mindfulness processes Commitment and behaviour change processes Psychological Flexibility *Four processes constitute mindfulness from an ACT perspective

17 Psychological flexibility: levels of explanation & measurement
The technical explanation seems to appeal more to researchers and those concerned with underlying theory. The mid-level explanation seems to appeal more to practitioners and those concerned with models of health and behavioural effectiveness, and treatment approaches. However, with increasing interest in the area, researchers have begun to experiment with the middle level constructs as well. Whilst it’s important that middle level constructs do not replace the basic principles they represent, continued work needs to be conducted on how the two may be linked. Published research which has experimented with these middle level constructs will now be reviewed.

18 Psychological flexibility & ACT in healthcare settings

19 Psychological flexibility processes
Previously discussed studies all focussed on office-based work environments. There are particular challenges associated with working in healthcare settings. McCracken & Yang (2008) Psychological flexibility Mindfulness Values-based action Hayes, Bissett et al., (2004) Cognitive defusion Psychological Flexibility

20 Contextual analysis of physical rehab workers (McCracken & Yang, 2008)
Key Q: How do psychological flexibility, mindfulness, and values-based action operate in physical rehabilitation workers? Interested in the combined and unique relations of each of these processes to stress, burnout symptoms, health and wellbeing. Key findings: as a group the processes accounted for a significant amount of variance in each of the outcomes (e.g., up to 61% in emotional functioning). When considered individually, psychological flexibility was the best performing predictor (showing significant relationships with 6/10 outcomes), with mindfulness and values-based action joint second (both showing significant relations with 4/10 outcomes). Preliminary study showed that each of the processes may have unique significant, beneficial effects on worker health and wellbeing in this setting.

21 Stigma and burnout in counsellors (Hayes, Bissett et al., 2004)
Key Q: How effective are different stigma-reduction interventions in improving negative attitudes and emotional burnout in substance abuse counsellors? ACT-based training Multicultural training (MT) Educational (treatment as usual) condition focussing on the biological basis of addiction Key findings: At follow-up ACT, but not MT, was superior to the education condition in reducing the frequency of stigmatising attitudes. ACT was also significantly more effective than MT in reducing emotional burnout. The stigmatising attitudes believability scale (SAB) (population-specific measure of cognitive defusion) mediated significant improvements in the ACT group.

22 Psychological flexibility & ACT in the workplace: recent developments

23 ACT & leadership (Bond, in prep)
Examined the ability of ACT to enhance leadership skills in financial traders. Transformational leadership describes the ability to influence followers to transcend personal interests, and transform themselves into agents of collective achievement. Involves idealised influence, inspirational motivation, intellectual stimulation and individualised consideration. Transformational leadership + ACT training Transformational leadership + trading laws training Traders in the ACT group ran teams that made significantly more money in trading over the following six months. This difference was mediated by an improvement in the ACT leaders’ transformational leadership skills, as rated by their team members. Furthermore, an increase in the ACT leaders’ psychological flexibility mediated this increase in their transformational leadership skills.

24 Integrating stress frameworks (Lloyd, Bond & Flaxman, in prep)
Examined how stress and emotional burnout may operate together, and furthermore impact one another, during an ACT worksite intervention. Research and theory suggest that while stress and emotional burnout are conceptually distinct, they are related (time-linked). ACT vs. No treatment (waitlist control) group ACT training led to significant improvements in stress and depersonalization component of emotional burnout. Mediation analyses indicated that initial increases in psychological flexibility explained contemporaneous improvements in stress, and that these improvements in stress, in turn, accounted for overall reductions in depersonalization.

25 Further examining ACT processes (Flaxman, Soderberg, Bond & Lloyd, in prep)
Examined the impact of an ACT worksite intervention on psychological distress, affective wellbeing, and life satisfaction. Suggested that improvements would occur due to a change in the individual ACT processes of acceptance and committed action. Focus on ACT’s hypothesised link of increasing experiential acceptance in order to facilitate subsequent behavioural change. ACT vs. No treatment (waitlist control) group ACT training led to improvements in all outcomes. Improvements in emotional acceptance and, to a lesser extent, committed action accounted for changes in outcomes. Also found that the impact of ACT on committed action was explained by an increase in emotional acceptance.

26 Measuring psychological flexibility at work (Bond, Lloyd & Guenole, in prep)
Research suggests that psychological flexibility is an important construct within the workplace. AAQ-I & II most popular method of measurement. Nevertheless, research has begun to demonstrate the utility of measures which assess psychological flexibility in relation to more specific disorders and syndromes (e.g., chronic pain, diabetes management, smoking cessation, body image etc). Face validity of general AAQ in the workplace can be problematical. Work-related AAQ (WAAQ) to assess psychological flexibility as the construct relates to thoughts and feelings occasioned by different aspects of work. Example item “I am able to work effectively in spite of any personal worries that I have”

27 Conclusions Research over the last ten years has shown us that psychological flexibility is a useful construct within the workplace, both as a predictor of important health and behavioural effectiveness outcomes, as well as an individual quality that we can manipulate. Research has demonstrated these effects across a range of occupations in both the public and private sector. We need to pay close attention to levels of explanation and how they impact measurement and assessment, as these have important implications for the conclusions that can be drawn from our work. The findings of our research in this area are important since they point towards the utility of modern behavioural interventions for bringing about meaningful organisational change.


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